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A rare case of sequential visceral artery aneurysm rupture associated with multifocal vascular abnormalities 继发性内脏动脉瘤破裂伴多灶性血管异常的罕见病例

IF 1.4 4区医学

Legal Medicine Pub Date : 2026-04-01 Epub Date: 2026-02-12 DOI: 10.1016/j.legalmed.2026.102815

Beatrice Benedetti , Caterina Pesaresi , Alberto Chighine , Luigi Carbone , Fabio De-Giorgio

{"title":"A rare case of sequential visceral artery aneurysm rupture associated with multifocal vascular abnormalities","authors":"Beatrice Benedetti , Caterina Pesaresi , Alberto Chighine , Luigi Carbone , Fabio De-Giorgio","doi":"10.1016/j.legalmed.2026.102815","DOIUrl":"10.1016/j.legalmed.2026.102815","url":null,"abstract":"<div><div>Visceral artery aneurysms (VAAs) are rare but potentially fatal, with rupture representing their most serious complication. We report the case of a previously healthy 35-year-old woman who presented to the emergency department with acute abdominal pain caused by rupture of a splenic artery aneurysm, resulting in massive hemoperitoneum. She underwent emergency laparotomy with splenectomy, but approximately one hour postoperatively developed recurrent hemorrhagic shock, necessitating a second surgical intervention with proximal splenic artery ligation. Postoperative CT revealed multiple visceral aneurysms, including rupture of a hepatic artery aneurysm, along with renal and hepatic ischemia. The patient died before angiographic evaluation could be performed.</div><div>Autopsy revealed sequential rupture of the splenic and hepatic artery aneurysms, accompanied by approximately 400 mL of blood-stained fluid within the peritoneal cavity. The right kidney showed two aneurysmal dilatations involving the hilar and proximal arterial segments. Examination of the left anterior descending coronary artery demonstrated a parietal dissection with intramural hemorrhage. Death was attributed to cardiac arrest secondary to hemorrhagic shock caused by the sequential rupture of the splenic and hepatic aneurysms, compounded by hemodynamic instability related to right renal artery dissection. Additionally, the pre-existing coronary artery dissection may have aggravated the outcome by limiting myocardial oxygen reserve during the critical period of aneurysm rupture. This case underscores the diagnostic difficulty of visceral artery aneurysms, particularly in young individuals without traditional risk factors, and highlights how multifocal vascular wall abnormalities can exacerbate clinical outcomes, even in the absence of overt rupture in all affected vessels.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"82 ","pages":"Article 102815"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Removal notice to “Application of forensic SNP genealogy and mitochondrial sequencing to a 28-Year cold case” [Legal Med. 82 (2026) 102836] 删除“在28年悬案中应用法医SNP家谱和线粒体测序”的通知[法律医学，82(2026)102836]。

IF 1.4 4区医学

Legal Medicine Pub Date : 2026-04-01 Epub Date: 2026-05-11 DOI: 10.1016/j.legalmed.2026.102862

Yu Cao , Sijing Hao , Bicheng Meng , Tiezhu Liu , Wenjie Qi , Huixin Zhao , Chenhua Xu , Fan Yang , Hui Li

引用次数: 0

IF 1.4 4区医学

Legal Medicine Pub Date : 2026-03-01 Epub Date: 2026-01-27 DOI: 10.1016/j.legalmed.2026.102800

Fatih Hitami Usluoğulları , Volkan Aydin , Selin Cabuk , Narin Akici , Ahmet Akici

{"title":"Drug-related suicidal events in children and teenagers: Age-stratified insights from FAERS","authors":"Fatih Hitami Usluoğulları , Volkan Aydin , Selin Cabuk , Narin Akici , Ahmet Akici","doi":"10.1016/j.legalmed.2026.102800","DOIUrl":"10.1016/j.legalmed.2026.102800","url":null,"abstract":"<div><h3>Objective</h3><div>Medications are frequently reported in association with suicidality in youth, yet age-specific risks within reported cases remain unclear. We aimed to analyze drug-related suicide among children and adolescents in the FDA Adverse Event Reporting System (FAERS).</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of FAERS reports from 1997 to 2024 that involved 5–19-year-olds and any suicide-related events. We described demographics and age-/sex-stratified adjusted reporting-odds ratios (aOR) for fatality; a 2014–2024 window confirmed robustness.</div></div><div><h3>Results</h3><div>We identified 18,779 cases, most from 13 to 17-years; girls constituted the majority (58.3%) except in the 5–12-years group. Completed-suicide reports accounted for 22.3% overall, rising from 6.9% (5–12 years) to 32.0% (18–19 years). Diphenhydramine showed the highest odds of reported death (aOR 8.2, 95% CI: 6.3–10.7), followed by oxycodone (6.7, 4.7–9.5) and bupropion (5.6, 4.6–6.9), stable in the last-decade subset. Age-dependent increase in reporting odds of death for risperidone (7.4, 3.3–16.5), atomoxetine (3.3, 1.6–7.1), and montelukast (2.8, 1.2–6.3) reversed after 18 years. Fluoxetine and quetiapine were associated with death predominantly in girls, whereas venlafaxine and paroxetine were more prominent in boys.</div></div><div><h3>Conclusion</h3><div>Across FAERS youth suicide reports, drug-associated fatality risk varies markedly by drug, surges in mid- to late adolescence, diverges by sex and shifts at both age extremes. These heterogeneities underscore the need for age-appropriate pharmacovigilance and trial strategies rather than direct extrapolation from adult data, particularly regarding the safety of drugs associated with suicide.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"81 ","pages":"Article 102800"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Transcriptomics in forensic entomology: Research progress and prospects 法医昆虫学转录组学研究进展与展望。

IF 1.4 4区医学

Legal Medicine Pub Date : 2026-03-01 Epub Date: 2026-02-06 DOI: 10.1016/j.legalmed.2026.102801

Jiangtao Mei , Siqi Liu , Hongxu Tao , Shuixiu Xia , Yu Wang

{"title":"Transcriptomics in forensic entomology: Research progress and prospects","authors":"Jiangtao Mei , Siqi Liu , Hongxu Tao , Shuixiu Xia , Yu Wang","doi":"10.1016/j.legalmed.2026.102801","DOIUrl":"10.1016/j.legalmed.2026.102801","url":null,"abstract":"<div><div>The rapid development of transcriptomics technology has brought revolutionary breakthroughs to the field of forensic entomology, demonstrating significant potential in addressing critical issues such as postmortem interval (PMI) estimation. This review summarizes the research progress and future prospects of transcriptomics in forensic entomology. In species identification, traditional morphological methods and DNA barcoding techniques have limitations, while molecular markers such as SSRs and SNPs developed from transcriptomic data demonstrate significant potential for enhancing the differentiation of closely related species, thereby providing new tools for accurate identification. For PMI<sub>min</sub> estimation, transcriptomics enables high-precision quantification of insect age by analyzing stage-specific gene expression patterns and integrating bioinformatics approaches, thereby overcoming the subjectivity of traditional morphological methods. Additionally, transcriptomics facilitates the discovery of olfactory and resistance genes in necrophagous insects, offering molecular insights into pre-colonization intervals and developmental regulation under extreme environmental conditions. In the future, combining transcriptomics with multi-omics technologies and optimizing data analysis methods will provide comprehensive theoretical support and practical guidance for forensic entomology, significantly driving its advancement.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"81 ","pages":"Article 102801"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Alteration of amino acid racemization rates of dentin via aspartate aminotransferase: A pilot study 通过天冬氨酸转氨酶改变牙本质的氨基酸消旋速率：一项初步研究

IF 1.4 4区医学

Legal Medicine Pub Date : 2026-03-01 Epub Date: 2026-01-04 DOI: 10.1016/j.legalmed.2026.102776

Saki Minegishi, Hisako Saitoh, Jun Ohta, Hajime Utsuno, Shuuji Namiki, Maiko Toya, Koichi Sakurada

{"title":"Alteration of amino acid racemization rates of dentin via aspartate aminotransferase: A pilot study","authors":"Saki Minegishi, Hisako Saitoh, Jun Ohta, Hajime Utsuno, Shuuji Namiki, Maiko Toya, Koichi Sakurada","doi":"10.1016/j.legalmed.2026.102776","DOIUrl":"10.1016/j.legalmed.2026.102776","url":null,"abstract":"<div><div>In forensic medicine, amino acid racemization (AAR) of dentin is one of the most precise methods for age estimation. However, AAR requires preparing for a wide age range for the same type of target teeth, which is one reason why AAR is not widely used. The purpose of this pilot study was to vary AAR rates by performing enzymatic reactions of aspartate aminotransferase (AST) and α-ketoglutarate. We used amino acids extracted from 10 mg of dentin, which was obtained from two maxillary third molars (age, 22 years). Furthermore, we examined AAR rates by performing gas chromatography under various conditions, including AST (0.1 U or 0.2 U), pH 7.8, 37 °C, 5–30 min, and with or without α-ketoglutarate. The results showed that AAR rates differed significantly among the conditions (<em>p</em> < 0.01). Furthermore, we attempted to estimate age based on the variation of AAR rates by using a calibration curve for 13 maxillary third molars (17–74 years, r = 0.859) and obtained AAR rates corresponding to 12–139 years. The results revealed that AST can be used to easily determine the AAR rates of L-aspartic acid, might demonstrate the potential for age estimation by racemization in forensic medicine.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"81 ","pages":"Article 102776"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145957814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pierced by Force: Forensic reconstruction of two fatal High-Energy Workplace impalements 武力刺穿：两个致命的高能工作场所刺穿的法医重建。

IF 1.4 4区医学

Legal Medicine Pub Date : 2026-03-01 Epub Date: 2026-02-03 DOI: 10.1016/j.legalmed.2026.102806

Julia Babigian , Alberto Amadasi , Marc Windgassen

{"title":"Pierced by Force: Forensic reconstruction of two fatal High-Energy Workplace impalements","authors":"Julia Babigian , Alberto Amadasi , Marc Windgassen","doi":"10.1016/j.legalmed.2026.102806","DOIUrl":"10.1016/j.legalmed.2026.102806","url":null,"abstract":"<div><div>Impalement injuries represent a rare but forensically relevant form of penetrating trauma that combines characteristics of both blunt and sharp force injury. The mechanisms and reconstruction of such injuries are often complex, particularly in the context of high-energy occupational accidents. Two fatal occupational cases with unusual impalement-like mechanisms are presented. In the first case, a construction worker was struck by a falling metal scaffold tube, resulting in a vertical cranial impalement with destruction of the occipital region and posterior skull base. In the second case, a worker in a high-voltage tunnel sustained fatal injuries caused by a recoiling steel cable, leading to complete transection of the trachea and near-complete rupture of the aorta. Postmortem computed tomography (PMCT) in both cases enabled detailed three-dimensional reconstruction of the injury mechanisms and confirmed the high-energy trajectories of impact. These findings illustrate that impalement injuries, from a forensic perspective, should not be restricted to classical transfixion events. Complex high-energy mechanisms involving secondarily accelerated objects—such as falling rods or recoiling cables—can produce functionally equivalent injury patterns. Their forensic assessment requires interdisciplinary analysis integrating radiological, biomechanical, and technical expertise.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"81 ","pages":"Article 102806"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A novel ACTA2 variant in sudden fatal familial thoracic aortic dissection: literature review and genotype-phenotype expansion 猝死致死性家族性胸主动脉夹层中一种新的ACTA2变异：文献回顾和基因型-表型扩展。

IF 1.4 4区医学

Legal Medicine Pub Date : 2026-03-01 Epub Date: 2026-01-21 DOI: 10.1016/j.legalmed.2026.102790

Lin Lihua , Duan Yijie , Huang Jing, Hou Jiaqi, Chai Qianqian, Pan Meichen, Du Jianghua, Liu Qian

{"title":"A novel ACTA2 variant in sudden fatal familial thoracic aortic dissection: literature review and genotype-phenotype expansion","authors":"Lin Lihua , Duan Yijie , Huang Jing, Hou Jiaqi, Chai Qianqian, Pan Meichen, Du Jianghua, Liu Qian","doi":"10.1016/j.legalmed.2026.102790","DOIUrl":"10.1016/j.legalmed.2026.102790","url":null,"abstract":"<div><div>Thoracic aortic dissection (TAD) is a life-threatening emergency frequently linked to underlying genetic variants, particularly in familial cases. Molecular autopsy has become increasingly valuable in forensic practice for identifying occult heritable disorders when routine autopsy alone cannot fully clarify the cause of death. Here, we report a 17-year-old male who died suddenly due to pericardial tamponade caused by ruptured TAD. Gene testing identified a novel <em>ACTA2</em> variant, c.155_162delinsGCACA. This indel leads to two amino acid substitutions (p.K52_D53delinsST) and a deletion (p.S54del), involving evolutionarily conserved residues. Histological examination showed aortic medial degeneration, characterized by elastic fiber rupture and disorganized arrangement of smooth muscle cells. Family screening confirmed the variant was inherited from his mother, with his elder sister also carrying it; both the mother and sister exhibited abnormal aortic calcification and congenital heart disease. Our systematic review revealed that pathogenic <em>ACTA2</em> variants frequently involve multiple organ systems. This multisystem pattern enhances the forensic value of genetic testing by providing additional phenotypic clues that help determine the underlying cause of sudden death when routine autopsy findings are insufficient. By identifying this novel variant, our study expands the <em>ACTA2</em> variants spectrum relevant to forensic molecular autopsy and reinforces the importance of incorporating postmortem genetic testing into death investigations, particularly in unexplained fatal aortic events.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"81 ","pages":"Article 102790"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Factors influencing the incidence of cervical spine/cord injury and severe injury caused by falls 影响跌倒致颈椎/脊髓损伤及严重损伤发生率的因素。

IF 1.4 4区医学

Legal Medicine Pub Date : 2026-03-01 Epub Date: 2026-01-22 DOI: 10.1016/j.legalmed.2026.102791

Masaki Inoue , Takahiro Tomioka , Takato Murai , Marin Takaso , Mami Nakamura , Kazuki Takaoka , Masahito Hitosugi

{"title":"Factors influencing the incidence of cervical spine/cord injury and severe injury caused by falls","authors":"Masaki Inoue , Takahiro Tomioka , Takato Murai , Marin Takaso , Mami Nakamura , Kazuki Takaoka , Masahito Hitosugi","doi":"10.1016/j.legalmed.2026.102791","DOIUrl":"10.1016/j.legalmed.2026.102791","url":null,"abstract":"<div><div>Falls are major causes of trauma in older people, often resulting in cervical spine/cord injury, and may even be fatal. We aimed to identify factors associated with cervical spine/cord injury and severe injury caused by falls to aid forensic evaluation. We retrospectively analyzed data for 83 individuals who fell between 2011 and 2023 at Shiga University of Medical Science. The characteristics of the victim, cause of death, presence of cervical spine/cord injury, injury severity, part of the body making contact with the impact surface, properties of the impact surface, and fall height were evaluated. Injury severity was assessed using the Abbreviated Injury Severity score and Injury Severity Score (ISS). Severe injury with ISS ≥ 16 occurred in 39.8% of victims and cervical spine/cord injury in 21.7%. Logistic regression analyses revealed that body mass (odds ratio [OR] 1.063, 95% confidence interval [CI] 1.003–1.126) and the part of the body making contact with the impact surface (chest/abdomen <em>vs</em>. head/face, OR 0.074, CI 0.007–0.723) significantly influenced the incidence of cervical spine/cord injury, and fall height >3 m was significantly associated with severe injury (OR 11.473, CI 2.163–60.868). These findings demonstrate that the severity of injury depends on the fall height, whereas cervical spine/cord injury is influenced by body mass and the part of the body making contact with the impact surface. Therefore, the collection of scene information, including the fall height, and body mass and posture are critical for postmortem examinations. Autopsy should be considered when cervical spine/cord injury is suspected.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"81 ","pages":"Article 102791"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Shot or buckshot? The evidentiary value of ballistic and forensic medical expertise in a case of homicide and personal injury 霰弹还是铅弹？在杀人案和人身伤害案中，弹道和法医专业知识的证据价值。

IF 1.4 4区医学

Legal Medicine Pub Date : 2026-03-01 Epub Date: 2026-01-20 DOI: 10.1016/j.legalmed.2026.102794

Eleonora Micaela Ertola , Euprepio Caprino , Tommaso Berloco , Gianpiero D’Antonio , Marco Albore , Cataldo Raffino , Giorgio Bolino

{"title":"Shot or buckshot? The evidentiary value of ballistic and forensic medical expertise in a case of homicide and personal injury","authors":"Eleonora Micaela Ertola , Euprepio Caprino , Tommaso Berloco , Gianpiero D’Antonio , Marco Albore , Cataldo Raffino , Giorgio Bolino","doi":"10.1016/j.legalmed.2026.102794","DOIUrl":"10.1016/j.legalmed.2026.102794","url":null,"abstract":"<div><div>This case highlights the crucial role of forensic sciences in reconstructing the dynamics of a firearms-related case involving two victims. G.D. died at the scene after being struck by three shots from a 12-gauge firearm loaded with 11/0 buckshot, causing massive bilateral hemothorax and aortic laceration. Autopsy revealed multiple pellet wounds consistent with this ammunition. C.D. was hospitalized with multiple injuries, including three entry wounds to each shoulder and grazing wounds to the left temporal region and right thoracic wall. Examination of seized evidence—cartridge cases, an unexploded cartridge, wads, and pellets—confirmed that all injuries were compatible with the same weapon and ammunition type. Ballistic analysis demonstrated that all cartridge cases were fired from a single firearm. G.D.’s injuries corresponded to shots from 3 to 7 m, while C.D. was struck by two shots from 10 to 12 m. Initial hypotheses suggesting the use of different weapons (birdshot and buckshot) were not supported; metallic fragments in C.D.’s temporal region were identified as fragments from a single buckshot pellet. Shooting distances were estimated based on pellet spread and wound patterns and confirmed through experimental test-firing.</div><div>In conclusion, the investigation confirmed that both the fatal injuries of G.D. and the non-fatal wounds of C.D. resulted from a single 12-gauge firearm using 11/0 buckshot. This case underscores the importance of a combined medico-legal and ballistic approach for accurately evaluating firearm injuries and reconstructing shooting events.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"81 ","pages":"Article 102794"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Histiocytic myocarditis: A rare and complex cause of cardiogenic shock 组织细胞性心肌炎：心源性休克的一种罕见而复杂的病因

IF 1.4 4区医学

Legal Medicine Pub Date : 2026-03-01 Epub Date: 2026-01-21 DOI: 10.1016/j.legalmed.2026.102795

Tommaso D’Anna , Beatrice Belmonte , Elisabetta Orlando , Eleonora Formisano , Ginevra Malta , Antonina Argo , Stefania Zerbo , Ada Maria Florena , Emiliano Maresi

{"title":"Histiocytic myocarditis: A rare and complex cause of cardiogenic shock","authors":"Tommaso D’Anna , Beatrice Belmonte , Elisabetta Orlando , Eleonora Formisano , Ginevra Malta , Antonina Argo , Stefania Zerbo , Ada Maria Florena , Emiliano Maresi","doi":"10.1016/j.legalmed.2026.102795","DOIUrl":"10.1016/j.legalmed.2026.102795","url":null,"abstract":"<div><h3>Introduction</h3><div>Histiocytic Myocardial Inflammatory Disease (HMID) is a rare and under-recognized form of myocarditis, characterized by predominant histiocytic infiltration within the myocardial tissue. Unlike more common lymphocytic and eosinophilic forms, HMID remains diagnostically challenging, particularly in children. Here we present a pediatric case, outlining the clinical course and the difficulties encountered, and highlighting the histopathological and immunohistochemical features essential for establishing the diagnosis.</div></div><div><h3>Case description</h3><div>A 4-year-old girl accompanied by her parents, who showed up at the hospital with persistent fever, abdominal pain, and vomiting. A cardiac evaluation revealed a mild pericardial effusion with preserved systolic function. Doctors treated her with corticosteroids and broad-spectrum antibiotics, but her condition rapidly deteriorated, resulting in cardiogenic shock and death from cardiac arrest. We performed a forensic autopsy that included histopathological examination and immunohistochemical analysis of the cardiac muscle (in particular in the right ventricle). The CD68 positivity highlighted the presence of a diffuse infiltrate of hystiocites. CD3, CD4, CD8, and CD20 staining showed only scarce lymphocyte representation. The child’s history gave no hint of autoimmune or inflammatory disease, underscoring the abrupt and unexpected nature of her illness.</div></div><div><h3>Discussion</h3><div>HMID is rare but can mimic common myocarditis, complicating diagnosis. Its fulminant course requires early recognition and confirmation by histopathology and immunohistochemistry. This case shows the importance of recognizing HMID in pediatric cardiogenic shock or sudden cardiac death of unclear cause.</div></div>","PeriodicalId":49913,"journal":{"name":"Legal Medicine","volume":"81 ","pages":"Article 102795"},"PeriodicalIF":1.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0